Diagnose on Sight: Swollen gums
Case: A 19 year old male with no past medical history presented with 4 days of painful oral lesions, swollen gums that bled easily, and fever. His temperature was 38.5C. Which of the following is true regarding this patient’s diagnosis?
[su_spoiler title=”Answer” style=”fancy” icon=”caret”]
It is treated with chlorhexidine and metronidazole
Acute necrotizing ulcerative gingivitis (ANUG), also known as trench mouth, is an acute infectious intraoral disease characterized by red, ulcerated gingiva, halitosis, friable mucosa and punched out interdental papillae. Fever, malaise, and lymphadenopathy are often present.1
The term “trench mouth” was coined during World War I when the disorder was seen in trench-bound young soldiers.2 It is most common in young males, and is associated with malnutrition, smoking, stress, immunosuppression, and poor personal hygiene. The infection is generally polymicrobial.3,4
Treatment includes local mouth care with hydrogen peroxide or chlorhexidine oral rinses. If systemic symptoms are present, oral antibiotics (metronidazole or penicillin) are indicated. Follow up with a dental clinic needs to be arranged to help reduce the likelihood of recurrence.4
Master Clinician Bedside Pearls5–7
Stacey L. Poznanski, DO
AWAEM President 2015-2016
Associate Program Director & EM Clerkship Director
Wright State University Boonshoft School of Medicine
Department of Emergency Medicine
Prabu Selvam, MD contributed significantly to the content of the podcast.
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